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INVOICE Begin Loading: WEIGHMASTER CERTIFICATE Arrive Job: THIS IS TO CERTIFY that the following described commodity Finish Unload: was weighed, measured, or counted by a weighmaster, whose Return Plant: accuracy, as prescribed by Chapter 7 (commencing with Section signature is on this certificate, who is a recognized authority of�� 12700) of Division 5 of the California Business and Professions Code, administered by the Division of Measurement Standards AUTHORIZED SIGNATURE of the California Department of Food and Agriculture. Excess water is detrimental to concrete quality. Increased water in concrete mix reduces strength and durability and increases shrinkage NOTE: Buyer accepts responsibility for water added on job site, which exceeds accepted water/cement ratio and workability specifications. Plant: Begin Loading: To Job: Arrive Job: Start Unload: Finish Unload: Leave Job: Return Plant: AUTHORIZED SIGNATURE Total Amount for This Ticket Not Including Standby Charges: Cash Check N / Auth Code: Check Charge Signature of Driver Receiving Cash: Cash Received: Total COD Order Amount to Collect Without Standby Charges: Customer Code: Customer Name: Project Code: Project Name: Ticket Date: Delivery Address: Delivery Instructions: Due On Job: Slump: Load: Truck Number: LOAD CUMULATIVE ORDERED MATERIALCODE QUANTITY I QUANTITY QUANTITY customer Job Number: Uraer Uo0e / uate: Deputy Weighmaster: Order P.O. Number: Map Page: Driver Number: I Driver Name: PRODUCTION DESCRIPTION Ticket Number: End Use: UOM I UNIT PRICE I AMOUNT Water Added Curb Line Crossed At Owner's SUB TOTAL IN GALLONS: Agent's Request: AUTHORIZED SIGNATURE TAX (-� Print Name: Date TOTAL INITIALS INITIALS Signature above signifies receipt and acceptance of the listed materials and acknowledge- ment of and agreement to the CEMEX terms and conditions. BATCH DATA 80UNIVERSAL Rev 4/12